Depression in patients with cancer may be associated with a higher mortality risk, according to findings from a large SEER-Medicare analysis presented at the 2026 American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract 195). The analysis found that psychotherapy soon after receiving a cancer diagnosis reduced the risk of cancer-specific mortality.
“Depression can be easy to miss in cancer care because symptoms such as fatigue, difficulty concentrating and loss of interest often overlap with the effects of cancer or its treatment,” said lead study author Edmund M. Qiao, MD, a radiation oncology resident at the University of California San Diego. “But when depression goes unrecognized or untreated, it can add another layer of difficulty at a time when patients need support the most. Our findings suggest that earlier screening and referral for psychotherapy could help address an important gap in comprehensive cancer care.”
Study Methods
Researchers sought to learn if and how depression impacts cancer mortality. They conducted a retrospective analysis of records from 265,639 Medicare beneficiaries of age 66 or older who were diagnosed between 2010 and 2017 with one of six common cancers: breast, colorectal, prostate, bladder, kidney, or non–small cell lung cancer (NSCLC).
The analysis focused on psychotherapy and antidepressants as common approaches to treating patients with depression. They identified patients who received psychotherapy through Medicare procedure codes, and medication through Medicare Part D claims. Treatment evaluation was conducted at 4 weeks, 8 weeks, and 12 weeks from the cancer diagnosis.
Key Findings
Among the analyzed patients, 22% had a diagnosis of major depressive disorder. These patients with cancer and depression had an 11% higher risk of cancer-specific mortality than those without depression.
Cancer-specific mortality rates at 1 year were 29% for patients who also had depression vs 21% without; at 5 years, the rates were 43% and 35%, respectively.
Patients with depression who received psychotherapy soon after their cancer diagnosis (within 4 weeks) had the biggest impact on lower their cancer mortality, though this only accounted for 3% of patients with depression in the full analysis. In adjusted analyses, these patients had a 21% lower risk of cancer-specific mortality vs patients with depression who did not receive psychotherapy. When receiving psychotherapy within 8 weeks, the risk was reduced by 13%, and 12% at 12 weeks.
Five-year cancer-specific mortality rates were 31% in patients who received psychotherapy and 44% in those who did not.
“Patients who connected with psychotherapy earlier tended to have better outcomes than those who did not receive it during that period,” Dr. Qiao said. “For oncology providers, these findings support identifying patients who may need mental health care and connecting them with appropriate services as early as possible.”
Antidepressant medications, used by 32.5% of patients with depression within 4 weeks of receiving their cancer diagnosis, did not lower cancer-specific mortality rates at any time point unless analysis adjusted for the type of cancer. “In the general population, psychotherapy and medication can both be effective ways to manage depression,” Dr. Qiao noted. “But cancer care adds context. A patient’s cancer type, prognosis, and treatment course may influence both their mental health needs and which interventions are most helpful.”
Depression was most commonly found among patients diagnosed with NSCLC (27%) and was least likely in patients with prostate cancer (13%). The association with higher cancer-specific mortality was significant across all cancer types, with prostate cancer demonstrating the strongest association.
When looking by cancer type, the association between psychotherapy and cancer-specific mortality was statistically significant for those with prostate, breast, and kidney cancers. There was a significant association between antidepressants and lowered cancer-specific mortality rate only for those with prostate cancer. Dr. Qiao suggested that there could be a more nuanced relationship between mental health and cancer outcomes than previously believed, which may require a more personalized approach to depression management.
The study authors noted, however, that due to the retrospective nature of the study, psychotherapy cannot be established as a direct cause of the reduction in cancer mortality risk. Future research is also needed to see if similar patterns are seen among younger patients with cancer.
“Depression is common among people facing cancer, but it is often under recognized and under treated. This study shows that timely treatment for depression is associated with better cancer survival. Patients who received treatment within 1 month of diagnosis had a lower risk of cancer death; it also shows that psychotherapy may potentially be underutilized given larger benefits over medication. Tailored and appropriate screening and referral for mental health care is an essential part of life-saving oncology care,” said ASTRO expert Fumiko Chino, MD, a radiation oncologist at The University of Texas MD Anderson Cancer Center in Houston.
DISCLOSURES: For full disclosures of the study authors, visit amportal.astro.org.
